Researchers say the increased popularity of the hookah - a water pipe used for smoking tobacco - may be caused by the social nature of the behavior coupled with the misguided belief that it is less harmful than cigarettes.

Study results showed that from 2005 to 2008, hookah use among all adults increased by more than 40 percent.

“This rise is particularly alarming because it’s happening in California, a state that leads the nation in tobacco control,” said UCSD Dr. Wael Al-Delaimy. “While cigarette smoking has decreased nationwide and in California, reports of ever using hookah have increased, especially among adolescent and young adults.”

Most users report smoking hookah with friends, according to Al-Delaimy.

“Though public indoor cigarette smoking is banned throughout California, hookah use is permitted in designated lounges,” he said. “This may create the impression that hookah is a safer alternative to cigarettes, which is simply not true.”

In 2008, hookah use in California was much higher among young adults – 24.5 percent among men and 10 percent among women – compared the national average of 11.2 percent among men and 2.8 percent among women. The study also found that hookah smoking among men and women was more common among non-Hispanic Caucasians with some college education.

“More specific studies are warranted, but we urge policymakers to consider laws that would ban hookah lounges, thus eliminating the implication that hookah smoking is safer and more socially acceptable than cigarette smoking,” said Al-Delaimy.